Basic Information
| Provider Information | |||||||||
| NPI: | 1164978722 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BOSTON BEHAVIOR LEARNING CENTERS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 109 OAK ST | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | NEWTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024641492 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6174674878 | ||||||||
| FaxNumber: | 6179165081 | ||||||||
| Practice Location | |||||||||
| Address1: | 109 OAK ST | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | NEWTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024641492 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6174674878 | ||||||||
| FaxNumber: | 6179165081 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2016 | ||||||||
| LastUpdateDate: | 09/01/2016 | ||||||||
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| AuthorizedOfficialLastName: | MACLEAN | ||||||||
| AuthorizedOfficialFirstName: | MARIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CLINICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6174674878 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | ED.D, BCBA-D | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103G00000X | 7235 | MA | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | 103K00000X | 583 | MA | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.